Ep 4: Why strength training is crucial to building confidence in your body

Michael Dermansky (00:02):

Hi, everyone, and welcome to the show that helps you become more confident in your body, so you can keep doing the things that you love. I’m Michael Dermansky, senior physiotherapist. And today I’m interviewing our senior exercise physiologist, Nick Adkins from MD Health and Templestowe. And he’s going to be talking about a topic he’s very passionate about, strength training.

Nicholas Adkins (00:21):

Hello.

Michael Dermansky (00:24):

So, Nick, strength training, we think it’s critical to building a confidence in your body. What are your thoughts?

Nicholas Adkins (00:34):

Well, strength is really the foundation of everything. Everything comes from strength, being able to simply lift or get up out of bed in the morning, or get up, ourselves out of a chair to strengthen your muscles, that allows you to do that. But it’s also the baseline for a lot of things we have to do in our life, such as power. So, moving quickly to run, to jump, to move away quickly, to throw a ball, to hit a ball with a bat, all requires strength to have that power to do that.

Nicholas Adkins (01:09):

And then also, to do things for a long period of time, such as to run for a period of time, such as a marathon or a triathlon, something like that, you require strength for your muscles to be able to contract consistently and quickly repeatedly over that long time. So, strength is really the foundation of everything. It’s like building a house. You’re not going to build a house with poor foundations. You’re not going to build a confident body with poor foundation. So if you don’t have the strength, you’re not going to be very confident in your body to do a lot of things that you want to do in your life.

Michael Dermansky (01:43):

Right. In your clinical experience as well, can you give us an example of where you can see where a lack of strength or good strength has made a difference in the client’s life?

Nicholas Adkins (01:56):

Usually, people with chronic pain are very deconditioned, which makes their life a lot harder, which then contributes to their painful experience.

Michael Dermansky (02:10):

Right.

Nicholas Adkins (02:11):

So things as getting up out of the chair hurts. They stop doing that. And then their muscles atrophy, and then getting out of the chair is even harder to do, and it still hurts.

Michael Dermansky (02:21):

Right.

Nicholas Adkins (02:23):

So, that’s a super basic example. And by simply just making their muscles stronger, we might be able to help their pain. Might not be able to help their pain, but to get out of the chair will be much, much easier.

Michael Dermansky (02:33):

Right. I see.

Nicholas Adkins (02:33):

And so that’s a super basic example. And then you can extrapolate that into examples of everyday life.

Michael Dermansky (02:40):

Right.

Nicholas Adkins (02:40):

From picking up the kids, taking out the garbage, moving things in the garden, yeah, it can go into any example in everyday life.

Michael Dermansky (02:50):

Right. I mean, I’ve seen an example particularly with arthritis, where people have hurt knee or hip arthritis and the pain hurts, so they stop doing things. And they don’t do strength work. So it becomes even weaker. It becomes harder to do the task, puts more pressure on it, and it becomes a vicious cycle.

Nicholas Adkins (03:06):

Yeah.

Michael Dermansky (03:07):

And so the fear is if I do stop, it’s going to hurt. It’s going to be worse. But that’s what’s leading to some of the problem. And when they make their body stronger, they can do those tasks a lot more despite the arthritis.

Nicholas Adkins (03:20):

Yeah, exactly right. And the funny thing is research actually shows us that even though it hurts, it’s not going to necessarily make the condition worse, like arthritis is a perfect example. Just because a movement hurts doesn’t mean you’re making the arthritis worse.

Michael Dermansky (03:36):

No. And bones like loading. They need-

Nicholas Adkins (03:38):

Yeah. Bones like being moved. They like being… And arthritis likes movement.

Michael Dermansky (03:42):

Yeah. So in your eyes, what does strength training mean?

Nicholas Adkins (03:49):

Lifting heavy, heavy things or pushing heavy, heavy things. So, for our muscles to adapt, for our muscles to get stronger, they have to be pushed. They have to be pushed hard. Not necessarily to their limits, but edging towards their limit. About 80% of their limit. If you lift a weight five times, but you can lift that weight 15 times easily, that’s not really strength training, because that’s easy to do. It’s not really pushing, pushing the body. Whereas, if you say lift the weight five times, but you can really only lift it about six or seven times, then that’s pushing towards this limit.

Nicholas Adkins (04:31):

So for me, strength training is pushing the body or pushing the muscles to a point of almost maximum fatigue.

Michael Dermansky (04:43):

Okay. Yeah.

Nicholas Adkins (04:43):

And it’s commonly done with the bench press, the deadlift, and then the squat, because those are three biggest movements. But it can really done with anything. It can be holding a weight when you do a step up. It can be picking up a weight and lifting it above your head, like a push press. It can be any exercise, but the weight needs to be relative to the goal.

Michael Dermansky (05:03):

Right.

Nicholas Adkins (05:04):

So it needs to be pushed.

Michael Dermansky (05:06):

So, from what I’m hearing as well, is that basically people will have different levels. So some people are stronger than others, but as long as you’re working to what is close to 80% of your limitations, is when you get the adaptation of the strength to occur. Is that right?

Nicholas Adkins (05:22):

Correct. Yeah. Yeah. And that can be simply getting up out of a chair, holding weight, holding a bag of rice, or something like that, that can make the act of getting up out of a chair more difficult to someone that they can only do it a short or a certain amount of time, which will elicit them strengthening gains.

Michael Dermansky (05:41):

What is the 80%? What’s the big deal about that? What effect is that going to have? So, I mean, okay, you lifted 80% of your maximum strength. What’s going to happen under the surface then?

Nicholas Adkins (05:55):

Your muscles get micro tears that forces them to be… That makes them adapt. So the body, what we do, protein goes into your muscles to create bigger muscles and makes the muscles grow.

Michael Dermansky (06:11):

Right. Okay.

Nicholas Adkins (06:11):

You also get increase in what’s called neuro drive, or an increase in [inaudible 00:06:17] bundles. So then the brain is just better at getting the muscle, get the muscle working.

Michael Dermansky (06:21):

Right. Okay.

Nicholas Adkins (06:23):

So, that’s a nutshell what goes on under the surface.

Michael Dermansky (06:25):

Right. So micro tears, is that a problem? I mean, you’re doing [inaudible 00:06:28]-

Nicholas Adkins (06:31):

Of course, no. No. It’s not. It’s not like a muscle tear, but when you use a muscle that does create, yeah, what are known as micro tears, but that’s completely normal.

Michael Dermansky (06:39):

Right. So you need to-

Nicholas Adkins (06:40):

That’s how muscles work.

Michael Dermansky (06:41):

Right. So you need to get a change in the muscles there, and then the micro tears triggers your body’s response to actually grow and adapt?

Nicholas Adkins (06:50):

Yeah. In a nutshell.

Michael Dermansky (06:52):

Yeah. I mean, that’s a fine balancing act between finding out how much to push to get adaptation, and then not too much, there’s the injury. It’s a very fine line.

Nicholas Adkins (07:01):

Yeah. But in saying that, the micro tear that I just spoke about is different from a muscle tear, muscle tear injury. They’re two very different things. They’re described… Tear is probably not the best word, but yeah, they’re two different things.

Michael Dermansky (07:17):

Right. Okay. So if someone’s not strong, why is that a problem?

Nicholas Adkins (07:24):

Well, it depends on what they want to achieve or what their goal is. If their goal is to be able to do something in particular, so a common goal we get is I want to be able to walk X amount of distance, or I want to be able to pick up my kids or pick up my grandkids easier. If they’re not strong, well, then completing that task is just going to be much more difficult. Like I spoke about before, strength is the foundation for everything. So, yeah, it really depends on what their goal is. If their goal is generally task orientated and physical, then their strength is going to impact that. Yeah. If they’re not relatively strong for their body, or their body type or body size, then that will just make achievement of the goal much, much harder.

Michael Dermansky (08:23):

Right. I’m going to add a little bit to that too, in terms of if you’re not strong enough, there’s a lot of metabolic reasons why that’s a problem. So, if you want to manage your diabetes, the muscle mass is the biggest thing that affects the glucose tolerance too. Yeah. So if your muscle mass isn’t there, you don’t have as many muscles of which the glucose sensors are on. And the volume of them is less too. So your ability to tolerate glucose is not as good.

Michael Dermansky (08:48):

Your bone density as well, you need muscle mass to load your bones. And bones need to be loaded if they want to minimize the risk of osteoporosis.

Nicholas Adkins (08:56):

Yeah. And then you can take that to the cardiac side of things as well. Bigger muscles helps increase blood flow to those muscles, but also helps you take the nutrients from the blood to build the muscle. And your heart adapts to resistance training as well. Everyone knows the heart adapts to aerobic based exercise, but with strength training, your heart adapts to that as well. Your heart is a muscle. It’s different to your skeletal muscle. But it is a muscle that does adapt to load. Your heart gets stronger.

Michael Dermansky (09:29):

Speaking of heart as well, you know the cardiovascular fitness as well, the surprising thing that’s come out in research the last few years particularly is how important strength training is in brain health as well.

Nicholas Adkins (09:41):

Yeah.

Michael Dermansky (09:41):

So this is one of the things we can really do to minimize the risk of dementia, is actually strength training. It has a direct effect on the blood vessels in the brain over the long term. It’s come out in the research again and again and again.

Nicholas Adkins (09:54):

Yeah.

Michael Dermansky (09:54):

One of the things that I often hear, and I know my opinion on this too, but I would like to hear yours in this, I often hear clients come and say, “I want to get fit. So, I’ll just go for a run. I’ll just go for a run.” Why is it important to work on strength if they just want to be better runners? I mean, I know the answer that I’ve seen over the years too, but what are your thoughts?

Nicholas Adkins (10:18):

Yeah. Well, again, it just comes back to what we spoke about before. If their goal is to run for a certain amount of time, well then their muscles need to have the strength to be able to repeatedly contract over that long period of time to sustain that speed for that amount of time. That’s the main thing. If their goal is to be better at running, but they simply just want to get fit, well, they’re not stress… Again, like we said before, they’re not stressing their body or they’re not stressing their muscles enough to adapt to strength, to improve their strength. They’ll get better at running. They’ll get better at running. And it depends on how deconditioned they are. They might build a little bit of strength just because they’re used to doing nothing.

Michael Dermansky (11:11):

Yes.

Nicholas Adkins (11:11):

But it’s still not going to be as effective as a strength training program could be. Like the minimal physical activity guidelines from World Health Organization is a combination of aerobic exercise, such as running, but it’s also the two resistance based exercise sessions that should be done a week as well. And that’s why strength is important for building fitness.

Michael Dermansky (11:41):

Yeah. I mean, what I’ve found as well is that often people will just go for a run and they just don’t have the strength power. So, their joints are taking way more load than they need to be. And that becomes a limiting factor. Their strength around the hips, their strength around their knees, strength around the ankles, that stops them from running what they want to, and they break something down. They get stress fractures. They get-

Nicholas Adkins (11:59):

Or, the tendinopathy.

Michael Dermansky (12:01):

Tendinopathy is a really common one too, because they just don’t have the strength. And so what do they do when they start getting these tendinopathies? They go to their physio or their osteo or their medical person, and they say, “You need to be stronger.” And they start building the strength, after they’ve had their injury. We’d like to see people do that before they hurt themselves.

Nicholas Adkins (12:17):

Yeah. Yeah, exactly right.

Michael Dermansky (12:20):

I mean, running is a repeat single load activity. It just… The same thing.

Nicholas Adkins (12:26):

Yeah. You’re repeatedly contracting over and over and over again.

Michael Dermansky (12:28):

You’re not overloading the muscles enough to actually force that change in strength.

Nicholas Adkins (12:33):

Yeah. Yeah. Like you said, a lot of other structures, if the muscles aren’t working as best they could be, a lot of other structures are taking the grunt, which they break down eventually.

Michael Dermansky (12:44):

Yeah.

Nicholas Adkins (12:45):

All the tissue has a fatigue and load capacity. Some are easier to build than others. Muscle is really easy to build, like we’ve just been talking about. But stressing passive tissue to adapt is a lot harder.

Michael Dermansky (13:00):

And they’re not necessarily made for that too, so the muscles aren’t strong enough.

Nicholas Adkins (13:03):

Exactly, yeah. Yeah. Yeah. Muscles are made to adapt and to either get stronger or get weaker based on what they’re doing. But say a ligament, that’s not really designed to get stronger. That’s got one role, which is just to help hold the joint in place.

Michael Dermansky (13:18):

So if it’s taking more loads than it should, it becomes a problem.

Nicholas Adkins (13:22):

Yeah.

Michael Dermansky (13:25):

Next question is an interesting one we hear, “I’m a female and I don’t want to bulk up. Why should I do strength training?” Because you’ve heard this many times before as well.

Nicholas Adkins (13:35):

Yeah. Yeah. And it is a common thing that pops up. Look, if it was easy to bulk up, I’d look like Arnold Schwarzenegger.

Michael Dermansky (13:42):

Right.

Nicholas Adkins (13:46):

Yeah. It’s not necessarily easy to… Like, you’re not going to turn into a gigantic body builder if you do strength training. Your muscles will change shape. And they’ll look a lot leaner. And that’s what gives that toned look that a lot of people are after when they start an exercise program, like you and I probably heard the same things with people’s goals, they just want to get stronger and more toned, when our definition of toned refers to something you see in upper neuron disease, with a high toned muscle or a spastic muscle. That’s what I think when people talk about toned.

Nicholas Adkins (14:32):

But I guess the general population’s idea of toned is a lean looking muscle. And that’s what strength training actually does. It makes your muscles change shape to a more leaned look. And they’re not necessarily going to bulk up massive. They might increase in size a little bit. But to bulk up to a level that people would think that they will requires a lot of dietary changes, and especially in women, for more testosterone, is a lot of supplementation as well.

Michael Dermansky (15:09):

Yeah. See, there’s a really big one there too. And women just don’t have the hormones to bulk up, unless they’re specifically taking supplements.

Nicholas Adkins (15:15):

Yeah, exactly right. So yeah, strength training isn’t necessarily going to make women bulk up. It will make them stronger and it will give them that lean look that they’re after. And you look at a lot of their, I guess celebrities who have… Like, a lot of women aspire to look like, a lot of them do strength training, and that’s how they-

Michael Dermansky (15:37):

They do strength training.

Nicholas Adkins (15:38):

Yeah. Exactly right. And that’s how they achieve that body.

Michael Dermansky (15:42):

Well, the biggest problem I see with young women is that they’re just not strong enough.

Nicholas Adkins (15:46):

Yeah.

Michael Dermansky (15:46):

So I see women in their thirties and forties, and they’ve got these issues they don’t need to have. And the biggest and primary reason is they’ve just lost strength. Life has got too busy, and they haven’t had time for themselves to do the work. And then, looking after their young kids is just hard work, and it doesn’t need to be.

Nicholas Adkins (16:04):

Yeah.

Michael Dermansky (16:04):

And you make a small change in strength over a three month period of time, their lives are so different.

Nicholas Adkins (16:09):

Yeah. And then the tough thing is strength training is tough work as well, which is why going back to our previous discussion about just going for a run, just going for a run is easy. You can put the kid in the pram and just run. But strength training is harder to do. You generally need equipment. It can be done without equipment, but it is better to do with equipment. But yeah, it is hard to do. And if your life is already stressful enough, or full of stressors, it’s harder to add something else on top of that.

Michael Dermansky (16:40):

The interesting thing about that too is though their life is going to be easier in three months or four months.

Nicholas Adkins (16:46):

Yeah, yeah, yeah, yeah. And that’s where you’ve got to get people to look at the big picture. Like it’s going to be harder in the short term, especially getting started, because you’re more likely to get [inaudible 00:16:55] as well, which sucks. But that is a normal part of exercising. Yeah. They’ll be much, much better further on down the track, even three months down the track when they’ve got some strength, they’ll realize that their daily activities are much, much easier to do. And that’s really just the start.

Michael Dermansky (17:15):

Another big question is I’m older, is it safe to do strength training work?

Nicholas Adkins (17:19):

Oh, 110%. Never too old to start, even if someone’s never done strength training in their entire life and they’re in their sixties, seventies, or eighties, it’s still completely safe. You do need to take certain things into consideration. And that’s why an assessment is really important, but it is incredibly safe to do. And I’d guess for older people, it will reduce the risk of things like falls and broken bones from falls, but also just improve their general health as well, like we spoke about before with the metabolic changes, bone changes, especially, and cardiovascular changes.

Michael Dermansky (17:59):

It’s interesting, there was a study that came out even this week in regards to strength training with a big analysis down here in Australia, in Melbourne, that showed how important strength training is to over 65s, that for muscle mass and for bone density, particularly around the hips, you can’t not do it. It’s one of the essential things you should do over 65.

Nicholas Adkins (18:22):

Yeah. Yeah. It’s one thing I hear a lot, is it’s too late to start. I’m too old to start strength training. It’s never too old. I’ve heard scenarios of people in their late eighties, in their nineties who have just started strength training and they improve significantly.

Michael Dermansky (18:42):

We have a few clients here. They’re in their nineties, that do strength training, and they’re living at home and having a functional life because they do strength training.

Nicholas Adkins (18:51):

Yeah. Just doing their normal movements or normal activities is much easier. There was a famous MRI study, I can’t remember when it was from, I think it was from the ’90s or early 2000s, is it shows… It takes an MRI, a cross-section MRI of two people’s thighs. They’ve got an older person who’s in their seventies who is physically active, one who’s not active, and younger people who are also not active. And you can easily see the differences between them, because the 70 year old physically active person has muscle bulk. You can see his muscle on the cross-section MRI, with a little bit of fat on the outside. Whereas, the 70 year old who doesn’t exercise, you can see a lot of fat on the MRI and a tiny little bit of muscle. So strength gains and building muscle lasts into those older ages.

Michael Dermansky (19:49):

Well, it’s interesting that with regards to that too, I mean, you do start to lose naturally, some muscle bulk over the age of 65. It takes that long. It’s not in the fifties and forties. It’s when you’re over 65.

Nicholas Adkins (20:00):

Yeah. But that’s why it’s even more important to maintain it, because you naturally do lose some, but you can slow that progression by exercising and by strength training.

Michael Dermansky (20:09):

And it’s completely outweighed by what people do. So the version, the amount people will lose or gain by strength training, it way outweighs what they will naturally lose from the passage of time. And that’s only over 65. Before that, the effects from age are nonexistent.

Nicholas Adkins (20:29):

Yeah.

Michael Dermansky (20:30):

Last couple of questions. I’m injured, it mustn’t be safe to do strength training.

Nicholas Adkins (20:38):

No, I’d say it’s very safe, depending on what the injury is. Like, there are some injuries that you do need to ease off the stress on it. But in saying that, you can still strength train on the areas around it. If someone has got, say a fracture in their foot, there’s absolutely no reason why they still can’t do strength training for the upper body, or on the other leg.

Nicholas Adkins (21:03):

But also in saying that, once an injury has got to a certain stage of healing, strength training actually then accelerates their healing, or facilitates it, is probably a better word, facilitates their healing, because you are stressing the tissue to become stronger. So if someone has got a muscle tear, for example, depending on how big the muscle tear is, once it’s healed to a certain point, and some laying down of collagen fibers has occurred, then we’re stressing that muscle to become stronger than it was previously. So the risk of it tearing is actually less, but the returning to full function is enhanced.

Michael Dermansky (21:42):

Right. Okay.

Nicholas Adkins (21:44):

Yeah. It’s very safe to do.

Michael Dermansky (21:45):

Well, it’s interesting, because the world has changed in the last probably 20 years, where treatment for injuries was much more passive and reliant on manual techniques. Now it’s strength training, strength training, training, strength training.

Nicholas Adkins (21:59):

Yeah.

Michael Dermansky (21:59):

If we want to make a change to an injury, and as early as possible.

Nicholas Adkins (22:03):

Yeah. You just need to be progressive about it, not doing what you… Let’s say you hurt yourself. You have to start a little lighter than you previously did. But then you gradually build back up and you’re fine within usually about four or six weeks. You’d be back to what you were doing previously, instead of just jumping straight back into it, where it might be too much stress at that point in time.

Michael Dermansky (22:24):

Right. So bringing things back a little bit so you can move forward?

Nicholas Adkins (22:27):

Yeah, exactly right.

Michael Dermansky (22:29):

But any reason you would think it’s unsafe for someone who’s injured to actually do strength work?

Nicholas Adkins (22:35):

Not that I can particularly think of. Again, it sort of comes back to what the injury is. But yeah, in the absence of a severe medical problem, I don’t see any reason why it’s not safe to do strength training.

Michael Dermansky (22:48):

No. And there’s a big mental reason for starting early with injuries as well, that to get over that anxiety barrier, it’s, “Oh, I can’t do this because I’m scared and I’m going to hurt myself.” No, you’re not.

Nicholas Adkins (23:02):

Yeah. Yeah, exactly.

Michael Dermansky (23:03):

I mean, breaking that fear barrier is a massive step, actually getting on with your life and getting away from an injury.

Nicholas Adkins (23:10):

Yeah. And that’s part of the healing process, where we have an injury, we always think about the physical side of it or the structure that’s healing, but there’s also the psychological side of it, of having that confidence to use that area again.

Michael Dermansky (23:22):

Yes. And just finally, Nick, any other benefits in strength training that we haven’t mentioned so far today?

Nicholas Adkins (23:30):

In my opinion, probably the only one we haven’t mentioned is the psychological effect of strength training, how empowering it can be. So, one of the things that I’ve noticed over the years with a lot of the older people, especially the older women doing strength training is they find it very empowering. You’ve got 60, 70 year old women who are lifting 40, 50 kilos, lifting more than what they weigh.

Michael Dermansky (23:58):

Yes.

Nicholas Adkins (23:59):

And they haven’t done that all throughout their entire life. Yeah. They find it very empowering. And then it’s even more empowering when they go away, say they go overseas and they’ve got to put luggage in the overhead apartment, how easy that is for them. They don’t need someone to come and help them. It helps them to maintain their independence, carrying their luggage upstairs to the hotel room, or something along those lines, they can do it themselves. Yeah. It’s very empowering.

Michael Dermansky (24:33):

Yes. I mean, that’s interesting that you brought up what we call internally the biopsychosocial model as well, of how all injuries and stuff has three components. There’s a physical component. There’s a psychological component. There’s a social component. And it’s like is it okay for me to do this? Well, yes. And do I feel like I’m able to do it? And that’s a major part of people actually having the best life they have, being okay with doing things as well as the physicality of it too.

Nicholas Adkins (25:01):

Yeah, exactly right. And that’s what builds a confident body, is being empowered by doing all these things.

Michael Dermansky (25:08):

Yes. Very good. Well, thank you very much, Nick, for coming down and talking to us about strength training as well. Next episode, we’re going to talk to one of our clients who is one of the people in this category. She’s done quite a bit of strength work with us, and she was very scared about it at the start. And now, it’s really going to make a big difference to her life. So we’ll join in next time to talk about a real life person who’s gone through all this process and how their life is different from that. Thank you very much.

Nicholas Adkins (25:36):

Awesome.